New CCU/ICU nurse frustrations!!

[MrsICURN14]

Hey guys!

I just need to vent for a minute, in hopes other nurses have had or have the same issues I'm dealing with.

I'm a brand new nurse who just graduated with my BSN and started working in a CCU/medical ICU at a level 1 Trauma center.

For the most part I have had good shifts with my preceptor, but over the weekend it was rough. I felt like she thought I was a complete idiot. I don't think she remembers what it's like to be a brand new nurse who has no idea what she's doing! It's so frustrating. Do I know how to shoot CO? Nope. Sure don't. So you'll have to stay in the room with me. She seemed very inconvenienced that she couldn't just go run around and let me do all the work. Isn't that the point of an internship-to learn!?

I didn't have any ICU experience working before this internship, and my critical care rotation in school sucked because I was at a lower acuity hospital and just didn't get super sick patients or many vents/swans etc. So 90% of this stuff is all new to me! I'm still learning SO much.

Does anyone else feel like sometimes these nurses expect you to know it all right out of the gate??

This weekend was the first time I drove home crying because I just felt defeated.

Advice and encouragement welcome!!

[Da_Milk_of_Amnesia, MSN]

Being that ou have no prior nursing experience, it will take you a fairly long time before you are comfortable with everything. Just remember to see the whole picture of what is going on with your patient. Tunnel vision will kill your patient. Treat your patient and not the numbers, new nurses get hypnotized by all the cool color waves on the screen and then they go treating numbers, titrating pressors and then they end up chasing their tail because of it. The biggest thing is to ask questions without being super annoying and if you don't know how to do something or what to do ASK. It will take you a good couple of months before you're comfortable in your own skin.

[Kissunshine, BSN, MSN, RN, APN, NP]

When I was doing my orientation on my icu, I also had a very hard time. Nurses on my units have 10+ or even 20+ yrs of experience and they don't believe ICU should have new grads, they think that we are not good enough yet to work in ICU so they are SO HARD on me. Alot of them are very very nice of course, but one person is enough to make your day difficult. I remember once i had an unstable patient in the morning and halfway throughout the day, my assignment was changed; i had to hand over my patient to another senior nurse and go prepare for an admission from OR. My charting/stuff were obviously not uptodate at the point and i didnt go on my break until late PM. I was hungry and dehydrated working my butt off....and later on i found out she went to our management to complaint about me because I left too much work for her to do. I was devastated. But I'm over it now...just have to let it go, not worth wasting your time/emotion.

[vivere]

I'm glad you wrote....I understand what you are saying. Sometimes I have seen preceptors expecting the new nurse to completely take over the difficult patient...it gives them a break. I'm not saying it's right. Everyone learns at a different pace. Back in the stone age when I was new, we didn't have as difficult patients as we do now in ICU. It was still a lot to learn, and it took me a full year to feel comfortable, and even now, I am still learning. You cannot remember everything. Keep a notebook, or box of index cards that you can refer to, especially for the mechanics behind the equipment. If you have your information readily handy, you will become the resource person for others, even as you are learning. Nurses are greatful to the geeky among us who can pull out a policy, or a drug formula for reference. I still refer to our unit's "cookbook" when I am using a drip. I don't rely on my memory. We get busy, we could make a mistake. Always reference. Remember the basics. How does the patient look? You will learn to assess at a glance when you enter the room. How is their color? Does the breathing look peculiar to you? Don't rely on the shift nurses who came before you....when it is YOUR patient, it is YOURS, and even the most seasoned among us can make an error with IV pumps, rates, calculations. If you master the art of assessment, you will be amazed at how quickly you will succeed. I am grateful for your reminder. We do tend to get impatient, please forgive us, and don't let it stop you. The patient has a right to have the best care! So, don't feel frustrated with yourself. Turn it back on the preceptor....and then look it up yourself. You will be a fine nurse, I have no doubt.

[vivere]

Note: To Kissunshine:

I have seen this many times. Just remember to jot things down if you can, especially when you have a difficult day as you described. Be ready for management with your own accurate facts about what occurred and don't be intimidated by senior nurses. Sometimes we are just old hens, pecking at nothing in the dirt. You know if you did a good job. You have your head on straight. Let it go. Don't be surprised if the tables get turned one day and you have an opportunity to be the better person.

[Ruby Vee, BSN]

Believe me, the senior nurses have not forgotten what it's like to be new, and most of them aren't out to intimidate or devastate a new grad. One of he more difficult parts of precepting (besides keeping your hands in your pocket to let the new grad acually DO stuff) is explaining things that we've been doing forever. You have to break a task down into it's component parts, and sometimes it takes four times as long to explain something, and then there's the holding your breath while the new grad DOES it. Most of the time I'm really good at all of that; other times no so much.

Your preceptor may have been having a bad weekend. You said she was usually nice, but this weekend was different. Perhaps she had something else going on and couldn' get her head into precepting? It happens. It would be nice to think we could all leave our emotions at home, but we're human and that isn't always possible.

ICU FAQs is a great resource. It explains things in simple enough terms that most new grads can grasp it -- and it's funny, too. Your educator is another resource. Expect to have to study at home on your off time -- it's part of acclimating to a new specialty, or in your case, a new profession. By all means ask questions if you don't understand something, but make an effort to try to understand it first. There's a difference between "Should I give the Coumadin?" and "Mr. Foley's urine is cherry red, is INR is 6 and his hemoglobin is dropping. He's due for Coumadin right now, and I'm thinking I should hold it. What do you think?" There's also a difference between "How do I do this?" and "I've never shot a cardiac output before, and I'm a little nervous. I understand the theory, but I'm shaky on the practice. Could you please come and watch me while I do it?"

Good luck with the rest of your orienation.

[Ruby Vee, BSN]

Note: To Kissunshine:

I have seen this many times. Just remember to jot things down if you can, especially when you have a difficult day as you described. Be ready for management with your own accurate facts about what occurred and don't be intimidated by senior nurses. Sometimes we are just old hens, pecking at nothing in the dirt. You know if you did a good job. You have your head on straight. Let it go. Don't be surprised if the tables get turned one day and you have an opportunity to be the better person.

I get it that you have a grudge against senior nurses. But a new grad is in no position to know whether or not she did a good job. New grads don't even know what they don't know. That's why they have preceptors. Sadly for you, most of those preceptors are senior nurses.

[vivere]

I get it that you have a grudge against senior nurses. But a new grad is in no position to know whether or not she did a good job. New grads don't even know what they don't know. That's why they have preceptors. Sadly for you, most of those preceptors are senior nurses.

Hey Ruby. I didn't get the impression that anyone had a grudge. I think people DO know if they have done their best, or not. Nursing is not just about the mechanics of nursing, to me. It is also about being a human being, making a connection with someone who needs your care, and trying to get along with the rest of the staff as well. I am a "senior" nurse, and I have also learned from new grads, about how to be compassionate to team members, how to go back and say "I think I came across a little harsh." I think new grads are already anxious enough, and trying to appear confident is part of it. Peace, Ruby Vee.

[Ruby Vee, BSN]

Hey Ruby. I didn't get the impression that anyone had a grudge. I think people DO know if they have done their best, or not. Nursing is not just about the mechanics of nursing, to me. It is also about being a human being, making a connection with someone who needs your care, and trying to get along with the rest of the staff as well. I am a "senior" nurse, and I have also learned from new grads, about how to be compassionate to team members, how to go back and say "I think I came across a little harsh." I think new grads are already anxious enough, and trying to appear confident is part of it. Peace, Ruby Vee.

I didn't say new grads don't know when they've done their best. I said they don't know when they've done a good job. They don't know what they don't know. It takes about two years before new nurses begin to have a solid grasp of the full range of what they don't know. There's a big difference between doing your best and doing a good job. (Well, for some folks it's a bigger difference than for others.)

Perhaps I'm getting sensitive about people putting down senior nurses. It's been happening a lot lately.

[jvelasq89, ADN, BSN, CNA, EMT-B]

I am in the same exact situation as you and have found that a book called "Critical Care made Incredibly Easy" by Lippincott Williams & Wilkins has helped tremendously. I am able to learn about procedures and equipment unique to ICU and when I am exposed to them at work I can now add the dots together. As long as your preceptor knows you are trying to learn and expand your knowledge they really can't be too annoyed.

[vivere]

great advice!